EGRR Adoption Application (Required fields **)

PayPal Transaction ID
First Name **
Last Name **
Street **
City **
State **
Zip Code **
** One of three phone numbers is required
Phone Day
Phone Evening
Phone Cell
Email **
Occupation
Best time to call
Personal Reference: Name
Personal Reference: Phone
Personal Reference: Relationship
Personal Reference: How long known
   
Your type of home?  
House
Trailer
Apartment
Condo
Other
   
Do you own or rent?
If you rent, do you have permission to have a dog?
Landlord's Name
Landlord's Phone Number
How long at this address?
Is your yard fenced?
Height and type of fence
Does it completely enclose the yard?
Could your dog escape your yard?
If you are not fenced, how do you plan to potty and exercise your dog?
How far do you live from a busy street?
Do you have a dog door?
Do you have an enclosed dog run?
If so, size and height of run:
Do you have a dog crate?
How many stairs do you have?
Do you have an in-ground or in-deck swimming pool?
Is it fenced?
Steps or ladder?
Number of adults in household?
Children, list age and gender:
Who will be the primary caregiver for the dog?
Is any family member opposed to adopting a dog?
Do any family members have an allergy to dogs?
List and describe regular visitors (human or animal) to your home:
Do you currently own dogs?
Breed, age and sex of each:
Are they neutered?
If no, why not?
What dogs (not listed above) have you owned on the past 10 years and explain what happended to each of them
Please give your dog training experience, including basic obedience
Do you own any cats?
How are they with dogs?
Do you own other animals?
List:
Do you have a regular veterinarian?
Vet Name
Vet address
Vet Phone
 
Pet Hunting
Obedience Agility
Therapy Work
Rally Flyball
Search and Rescue Service Work

What are your preferences (please check one)?  
Dog Preference
Color
Size
Age range
Is someone home during the day?
During the night?
On a scale of 1 to 10 (1 being extremely mellow and 10 being very very energetic and active), how active would you likeyour dog to be?
How active are you/your family?
On average, how many hours per day will the dog be without human companionship?
Where will the dog be when home alone
When family member is home?
Will the dog ever be tied out for any reason?
If so, explain
Where will the dog spend the night?
Have you applied to adopt a dog through another Rescue group?
Have you ever been refused an animal adoption?
Would you consider adopting a dog with special behavior or health needs?
Do you agree to have the dog spayed/neutered within 30 days if you adopt a dog that is not already surgically sterilized?
Under what conditions would you give up your dog?
Do you agree to a home visit be an EGRR volunteer?
How did you hear about EGRR?
Please write a short paragraph about why you want to adopt a Golden Retriever

Terms of Adoption

I understand that information provided to EGRR about a dog’s behavior or health by a previous home or owner might not be accurate and that no history will be available on a dog that came from a shelter. I understand that EGRR will make every attempt to provide as much information as they have available to them about the dog’s medical and behavioral history and that a dog may behave differently or have other issues in my home that were not evident in a foster home or previous home. I understand that EGRR’s role is to facilitate the adoption process and that it is my responsibility to see and evaluate the dog before deciding to adopt him and that the decision to adopt the dog is mine and mine alone. I agree to not hold EGRR or its representative responsible for any behavior, health or other issues that occur once I take possession of the dog. I agree to indemnify and hold harmless Evergreen Golden Retriever Rescue and it’s officers, members and/or agents from any claims for damages arising from actions, injuries, accidents, health or other issues of a dog adopted by me. Should the dog show signs of aggression after being adopted, I agree to notify EGRR immediately. EGRR has my permission to contact individuals and/or businesses listed in above responses.

 

I acknowledge that all of the above information is true and complete. I also acknowledge that I have read and agree to comply with EGRR’s Adoption Contract and should I be found in violation of these Terms of Adoption or the Adoption Contract I will, if requested, relinquish the dog to EGRR.

Mandatory Criteria for Adoption

This Contract lists the criteria that we feel are necessary to ensure a successful adoption and to provide a safe, secure and happy home for our Rescue Golden. As of the date of adoption, the golden adopted becomes the property of the adopter. However, at the same time EGRR reserves some rights regarding the animal in the case it is abandoned, mistreated or not cared for in a reasonable manner. The items listed below are considered to be crucial to the well-being of the adopted animal. These criteria must be followed. Although repossessing a dog is a very rare occurrence, EGRR is prepared to do so should we feel it necessary in order that the best interests of the dog may be protected, and his health and safety preserved.

 
I agree to keep the dog in my possession as my household pet and companion. The dog will live with me inside my house as a family pet. Should I be unable to keep the dog for any reason, I agree to not sell, abandon, transfer or dispose of the dog in any way, including to family members but instead notify and return the dog to EGRR.  
I understand that if I determine the dog I have adopted is not a good match for me or my situation, I am obligated to return the dog to EGRR and will transport the dog to wherever EGRR requests. If I do this within 30 days my adoption donation will be refunded but I am not entitled to and will not be reimbursed for any other expenses.  I also understand that the reason for returning the dog may influence EGRR’s decision to place another dog with me. 
I agree to provide quality and sufficient food, clean water, appropriate grooming and humane treatment for the dog at all times.   
I agree to ensure the dog’s safety by never allowing the dog to run loose without adequate adult supervision.  When the dog is outside and unattended, he/she will be in a securely fenced yard or run.  The dog will never be tied or chained outside without a responsible adult in physical attendance.  

I agree to provide regular veterinary care including appropriate vaccinations, and treatments of infections, illnesses and injuries as recommended by my veterinarian and to obtain veterinary care as soon as possible should the dog be injured or become sick.

I agree to have the dog surgically sterilized within 30 days of adoption or by an agreed upon date at my expense if the dog is not already altered and to provide proof of sterilization in writing to EGRR within 10 days of the surgery.  I will not allow the dog to breed or be bred under any circumstances.  
I agree to use a buckle collar on the dog when not training him/her and to attach the EGRR ID tag and a personal ID tag to the collar.  EGRR recommends that I have the dog micro-chipped as means of permanent identification.  With multiple dogs, no collar when inside is permitted. 
Within one month, I agree to license the dog according to the regulations in the community in which I live.  Additionally, I agree to obey all animal control regulations and to never transport the dog in the open bed of a pickup truck or similar vehicle without proper restraints as stated in Washington state law. 
I understand that taking my dog through a basic obedience class will greatly benefit my dog and will aide in the success of this adoption and I will make every attempt to do so at my expense. 
In order to fully protect the health and safety of the dog, I agree to allow an EGRR representative to examine the dog and his/her living conditions at any time if they have a reasonable belief that the dog is not being cared for in a proper manner.  If the dog’s living conditions are deemed unacceptable or if I have violated this Adoption Contract in any way, I agree to immediately surrender the dog to an EGRR representative.
I understand that EGRR makes every attempt to ensure that the dog being adopted is healthy and that I be advised of any known medical issues.  I understand that it is recommended that I have the dog checked by a veterinarian of my choice at my expense within 30 days to confirm the health of the dog.  I also acknowledge that since most of the dogs have unknown genetic backgrounds, I will not hold EGRR or its representatives responsible for medical afflictions including but not limited to its eyes, hips, heart, elbows or allergies. 
I understand that there are inherent risks associated with pet ownership and accept these risks for myself and my family, visitors to my home or other third parties.
I agree to assume full responsibility for any and all actions or damage done by the dog from the moment he/she comes into my possession.
I understand that EGRR is a referral service and that it is my responsibility to see and evaluate the dog before deciding to adopt him/her. I agree not to hold EGRR or its representatives responsible for any behavior that occurs once I take possession of the dog.  I understand that EGRR has no history on a dog that was obtained from a shelter and the information EGRR has from a previous owner may not be accurate.  Furthermore, I understand that EGRR’s foster homes are experienced dog owners and that an adopted dog may behave differently in my home than he/she behaved in the foster home.  Should the dog demonstrate any type of aggressive behavior I will notify EGRR immediately.
I affirm that I had the opportunity to review and ask questions as to all points and provisions of this Contract.
I understand that any controversy or claim arising out of or relating to this contract or the breach thereof shall be settled by arbitration before an arbitration attorney in King County, Washington, pursuant to the laws relating to arbitration.  The arbitrator may grant any relief and render any award which he or she deems just and equitable and within the scope of the agreement of the parties, including, but not limited to, specific performance.  Awards pursuant to this Article may include costs, including a reasonable allowance for attorney's fees, and judgments may be entered upon any award made hereunder in any court having jurisdiction in the premises.

I acknowledge that I have read and agree to comply with the mandatory criteria of the Adoption Contract as stated above.

Signature
Evergreen Golden Retriever Rescue requires that you certify your application by submitting an electronic signature. To certify your application, please provide an electronic signature (type your name) and click Confirm Signature and Submit. I certify that all the information in my application is accurate and true.
Enter Electronic Signature **

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